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High Birth Weight and Early Postnatal Weight Gain Protect Obese Children and Adolescents from Truncal Adiposity and Insulin Resistance: Metabolically Healthy but Obese Subjects?

1. Department of Pediatric Endocrinology, University Hospital, Angers, France
2. Department of Nuclear Medicine, University Hospital, Angers, France
3. Department of Biochemistry, University Hospital, Angers, France

recoutant{at}chu-angers.fr

ABSTRACT

Objective.: Low birth weight (LBW), no early catch-up weight, and subsequent fat accumulation have been associated with increased risks of insulin resistance from childhood onward and later cardiovascular disease. We sought to clarify the effects of high birth weight (HBW) and postnatal weight gain on insulin resistance.

Research Design and Methods.: One hundred and seventeen obese children aged 10.4 ± 2.4 years were divided into 3 groups according to fetal growth after exclusion of maternal diabetes. They were comparable for age, gender, puberty and percent body fat. Customized French birth weight standards, adjusted for maternal characteristics and gestation number, identified subjects with true altered fetal growth: 32 had increased fetal growth (HBWcust), 52 were eutrophic, and 33 had restricted fetal growth (LBWcust). Fat distribution by dual energy X-ray absorptiometry, insulin sensitivity indexes from an oral glucose tolerance test, and leptin, adiponectin, and visfatin levels were compared between groups.

Results.: The HBWcust subjects had a higher adiponectin level, higher whole body insulin sensitivity index (WBISI) and lower hepatic insulin resistance index, lower insulin and free fatty acid concentrations during OGTT, and lower trunk fat percentage than eutrophic (p<0.05) and LBWcust subjects (p<0.05). Besides birth weight, weight gain between 0 and 2 years was a positive predictor (p<0.05) of WBISI, whereas weight gain after 4 years was a negative predictor (p<0.05).

Conclusion.: High birth weight and early weight gain may program insulin sensitivity and adipose tissue metabolism and contribute to so-called metabolically healthy obesity.

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